The article focuses on the theme of power within health organizations, particularly in hospitals, emphasizing the ever present tension between control versus autonomy in its management process. Carefully examined is the hypothesis that democratic and participative management models, with a strong publicization of the institutional life, have been seen as controllists by the workers - which could be an apparent paradox through its autonomy creation discourse. The creation of multiple devices or negotiation contexts, in which multiple organizational rationalities meet and are confronted, is said to be an alternative for a radically democratic management, supported by the idea which says that no macroactor (the direction or the government) has got the power of imprinting the rationality of the organization without facing a complex, permanent and dialogical negotiation process which would involve all the organizational actors.